| NPI | 1215425988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME161967) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2024-02041) |
| 2086S0127X Surgery, Trauma Surgery (Licence: NC 2024-02041) | |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2025-05-21 |